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Saturday, August 31, 2013

I love nuts. I mean real nuts – not peanuts (although I love them too – I just don’t
eat them anymore). Peanuts are legumes and toxic to my health, but nuts – true TREE
nuts – are different. They’re all
good tasting, and all high fat,
of course, but some are much healthier than others, some are more of a toss-up,
and some should be avoided. The basis for determining that is largely the type of fats they contain, and
the rule here is the same as it is for all high-fat foods: saturated fat is
good; monounsaturated fat is also good, and polyunsaturated fat is good or bad depending on their
Omega 3 and Omega 6 fatty acids. Unfortunately, many nuts contain too many
Omega 6s and should just be shunned.

But before I categorize nuts according to fat type,
and particularly their polyunsaturated n6s and n3s, we need to talk about
context. If you eat three (or even two) small healthy meals a day, you will not be hungry. So, when would you eat nuts? 1) As a regular
between-meal snack? 2) If you should “feel” hungry on occasion? 3) At a social
gathering where nuts are one of the few offerings that are an “allowed” food?
Or 4) perhaps as a salad ingredient at a sit-down dinner?

For me, the answers are 1) Never as a between meal
snack. They are simply not needed; 2) I think you should listen to your body,
but not to your “head.” Your head can send false signals. The brain is very
adept at this. If I “feel” hungry (before or after dinner, the only times for
me), I “deny” the feeling. I distrust my “feeling.” I either tough it out, and/or
drink something non-caloric; 3) at a social gathering: I haven’t mastered this
one yet. I will usually succumb and eat the nuts. I will regret it later, but I
am weak when I SEE – that is, when I am VISUALLY seduced (conditioned?); 4) as
an ingredient of a dish, say a salad: I like this option, especially when the
main dish is low fat, like a non-fatty fish entrée.

Another issue is raw or roasted, unsalted or salted,
and/or otherwise coated. The answer, again for me, is roasted, unsalted or
salted, but otherwise not coated
(as in “honey roasted”!). Some people like raw, organic nuts and others like to
roast their own so they can control the heat and mediate the oxidation. Some
people prefer the taste or “health benefits” of unsalted. For me, I don’t obsess
about this. I like both unsalted and salted nuts and if I’m only going to add a
few unsalted nuts to a salad, it’s really not going to make much difference. To
summarize: for me, nuts then are only a “party option” (mea culpa) or a supplementary ingredient in a salad. Snacking and
emotional eating are verboten!

Remember, the issue with nuts is which ones contain
the fewest polyunsaturated Omega 6 fatty acids. Here is my list:

Note that cashews
and pistachios are not included on this list because, while
moderate in Omega 6s, they are too high in carbohydrates. Other dietary choices which offer good, moderate and
bad Omega-6 options as food choices are:

Nut oils, however, come with certain risks to health:
the higher the Omega-6 content, the greater the danger of damage from high heat
and chemicals in processing and manufacturing and the more likely they are to
become rancid on the shelf. After opening, high Omega-6 nut oils should be
refrigerated; they are fragile. And they should not be used in high heat food
preparations. The same principles apply to nut butters.

If
you’re influenced by the Paleo ideology, as I am, you might find it appealing
to think of tree nuts in the same way we should think of fruit: as a local,
seasonal treat. In today’s world, of course, that is no longer the case. Fruits,
hybridized to make them larger and sweeter, are often produced half-a-world
away are available year-round at the corner market, like fresh flowers from
Amsterdam or Columbia. Nuts are too, but in our culture they tend to be
consumed mostly during the holiday season from Thanksgiving to Christmas when
they are displayed at the front of the supermarket in large boxes and barrels.
These displays suggest to me the way we should think of both nuts and fruit: as
something special to be consumed as a treat, not as a staple, and then only “in
season.” I don’t mean to imply this in the literal sense. That would be orthorexic, and far be it for me to think
that way (LOL). I mean it in a way
that allows us to enjoy something special
on special occasions: something to
look forward to, like the first asparagus of spring or apples in October; or,
on my WOE, a warm main-course dinner salad of frisée, lardons, and sautéed Baby
Bella or Crimini mushrooms, all tossed in a homemade vinaigrette dressing and
topped with chopped hazelnuts and shaved Pecorino Romano (or a poached egg). Bon appétit!

Wednesday, August 28, 2013

Whenever
I am asked about what foods one “cannot” eat on a Low Carb Diet, the
prohibition on eating fruit is always the “3rd rail.” If you’re not
familiar with this term, on electrically operated trains, there are two types
of power: overhead systems and 3rd rails. Third rails run along the
ground between tracks on a 2-way system. They are very high voltage and very
dangerous. To touch them is to die. Like 3rd rails, life without fruit
to a prospective Low Carb Dieter is similarly “fatal.”

So,
some bloggers I otherwise admire and respect make an exception for fruit. They
have concluded to do otherwise would be to lose the battle advocating low-carb
eating before you are engaged. That’s cowardly. From my point of view, integrity
demands that I speak the truth to you. I love fruit too, just as I love pasta,
and rice and potatoes and bread, but
I have learned that my body no longer tolerates “sugar,” especially simple sugars (mono and
disaccharides). I also can’t eat any processed carbohydrates, as in virtually all packaged foods, and I can’t eat all of the starchier and sugary
vegetables.

Fruit is mostly sugar. Well, it’s mostly water, but all of the macronutrient nutrition is
sugar. An apple is 86% water, 3% fiber, and 11% simple sugars (0% protein and 0%
fat). The sugars are 20% sucrose, 57% fructose and 23% glucose. When the
sucrose breaks down to free fructose and free glucose, an apple is then 67% fructose
and 33% glucose. That’s all “simple sugar”!

It’s
true, an apple has some micronutrients (vitamins and
minerals in the skin), and the pulp has pectin, but there are other sources for
these important components in a basic “real food” diet that “cost” fewer otherwise
“empty” calories. Do not use these “good” components as an excuse to eat fruit.
Rationalization is just self-deception. Own up to it, my friend.

So,
what do you tell someone who wants to reduce their carbohydrate intake and who
loves fruit? Three common approaches are 1) don’t snack on fruit. In fact,
don’t snack at all, but if you must snack, snack on fat (like a
portion-controlled serving of nuts), and 2) if you must eat dessert, eat fruit
for dessert instead of ice cream or pie, and 3) eat mostly berries
(strawberries, raspberries, black berries and blueberries), with some fat like cream (but no added sugar!). Berries also
have phytochemicals, fiber, and minerals and vitamins too. But do not ever eat grapes, or cherries, or dried fruit!

Is
it possible to take a more moderate stance on the issue of fruit? Sure. As far
as your blood is concerned, all carbs are equal. They will all break down to
simple “sugars,” mostly glucose, some slower and some faster. If you are only
mildly carbohydrate intolerant, that is, if you have been told you are
“pre-diabetic,” you may be able to tolerate more “sugar” (glucose) in your
diet. But be careful. This is a very slippery and treacherous slope. You could,
for example, lower your carbs by a third or even two-thirds, and eat low carb, but not very low carb. Your meter will tell you what you need to
know.

But
this is a no-man’s land for both the patient and the clinician. Your doctor most
likely adheres to the practices and “Standards of Medical Care in Diabetes,” issued
by the American Diabetes Association. If you are overweight, and your A1c test,
which measures the glucose on the surface of your red blood cells, is elevated,
your physician will advise you that you are “at risk of diabetes.” Your doctor
will then probably tell you to lose weight by eating less (on a “balanced
diet”) and exercising more, but they won’t tell you to eat fewer
carbohydrates, and they won’t tell you to eat less
fruit. And they will definitely not tell you that if you do not change the foods you eat,
that your condition is progressive and that you will inexorably become a
full-blown type 2 diabetic. And that, my friend, is an irreversible diagnosis. Repeat:
Irreversible.

For some reason, doctors just don’t get
it, yet. The glucose in your food causes your blood sugar to rise, and if you
are insulin resistant, it (the glucose) will remain circulating in your blood.
The only way to lower your blood sugar, and your circulating (serum) insulin
that transports the glucose, is to eat fewer carbohydrates, including but not
limited to fruit. It’s that simple!

Today’s
fruit is different from the fruit of yesterday in two major respects: 1) it has
been hybridized to be sweeter and larger than it ever was in nature, and 2) it is
no longer a seasonal treat. Due to refrigeration and world-wide air
transportation, fruit is available everywhere year round. In cities today, it
is available in every street corner grocery store even in the middle of winter.
It is up to you to treat fruit as a treat: to eat it only occasionally, on very
special occasions.

I was inspired to
write this column by two recent incidents. First, I read a Q & A in “Diabetes Today” in which Dr.
Richard K. Bernstein referred to “sweet fruit” as something to be eaten
sparingly. He has been a type 1 for 69 years and has A1c in the 4s. He regards
a 5.8 as a full-blown type 2 diabetic. You don’t usually hear the phrase “sweet
fruit,” so it stuck in my mind. The other was an article, “Fruit Restriction
for Type 2’s: Good or Not?” in Diabetes in Control, a digest for
physicians. It compared two groups of newly diagnosed type 2s: one was told to
eat fruit only two times a week and the other “given the more common
conventional medicine advice to eat no more than 2 fruits a day.” After 3
months they measured A1cs, weight loss and waist size and found little
difference. They concluded, “We recommended that the intake of fruit should not
be restricted in patients with type 2 diabetes.” What idiots! What bleeping
idiots! This is “one size fits all” advice (writ large!)If you want to live (a long and healthy life)
with diabetes, eat to your meter! And eat fruit very, very infrequently!

Saturday, August 24, 2013

Once again, the Low Carb Diet News site keyed me in to another blogger who was new to me
and who thinks along the same lines as I do. He is a New Zealander named
Professor Grant Schofield, and he blogs on “The Science of Human Potential” here. He is also an
academic (Psychology) at the Auckland University of Technology, NZ, which leads
to an interesting digression in his post that I liked well enough to repeat here.
To quote “Professor Grant” (as he is known):

“A
second excellent review article was also published in Nutrition Today by Volek (again!) and Phinney, the low carb gurus.
This one is called “A New Look at Carbohydrate-Restricted Diets: Separating
Fact From Fiction”. Again this is an excellent scientific review paper. What I
should be doing in this blog is simply drawing your attention to this good work
and you can go and check it out for yourself. Except I’m aware that unless you
work at a university, that’s easier said than done. You’d have to buy the
papers, which means that most of the people who stand to benefit from the
knowledge won’t.”

How true. The new Volek and Phinney paper that the good professor
was referring to is published in “Nutrition Today,” for the journal’s pecuniary
benefit alone, and is available for $48 plus tax for this one article or $99
for an annual subscription. I passed on this offer, and am grateful that the
professor reviewed the piece for me (us). But just think of all the
practitioners out there, the very clinicians who would benefit from this the
most, who will never see it for lack of an academic appointment, and the time
to read it. What impediments we make to the advancement of learning!

Anyway, Professor Grant goes on to list his takeaway of the main
points of the Volek and Phinney scientific article. He does gets a bit “in the
weeds” so, as J. Stanton says on his Gnolls.net website, “CAUTION: CONTAINS SCIENCE.” The “Professor Grant” article, including the four points
below, is found here:

1.Saturated fat levels in the blood are not
associated with dietary saturated fat intake, but dietary carbohydrate intake.
They show evidence from both randomized controlled trials and population data
for this.

2.They discuss in detail what the keto-adapted
(fat adapted) state is; how this comes about, including increased beta
oxidation of fat, decreased hyperinsulinemia, and a re-orchestration of
substrate utilization in the body, including the use of ketones to fuel brain
function. It is interesting that the majority of practicing dietitians,
endocrinologists, cardiologists, and public health physicians have never heard
of any of this.

3.They point out what is a very important and
obvious set of outcomes, which are well documented in the scientific
literature; that treating a patient with insulin resistance with a low fat/high
carb diet is palliative and going to make the problem worse. If you are having
trouble getting glucose into your cells, then reduce the glucose load stupid!

4.They show a nice little diagram, which I have
reinterpreted and redrawn below, to show the role of dietary carbohydrate in
metabolic (dys)function. To quote the authors “The major point is that SFA
(saturated fatty acids), and the response to eggs, has a totally different
metabolic behavior when consumed in the context of a low carbohydrate diet.”

Here’s a link to Professor Grant’s re-interpreted JPG
diagram. The interesting aspect of Volek and Phinney’s thesis to me is
that first sentence in bullet Number 1 above, as illustrated in Professor
Grant’s diagram. Take a look, or a second look, at it. They are showing with “both
randomized controlled trials and population data for this,” that “high dietary
carbohydrates” (symbol: CHO) results in “SFA synthesis up” and “SFA storage up”
(we make and store more body fat in the form of triglycerides). That in turn,
in the “metabolic health continuum,” leads to “plasma SFA up” (high blood fat,
i.e. triglycerides), “insulin resistance up,” and “dyslipidemia up.”

The other side of the diagram shows that the inverse is true with
lower dietary carbohydrate intake. Okay, this is a little heavy on the science.
My wife likes to simplify it all by telling our friends and acquaintances that
“Eating fat doesn’t make you fat; carbohydrates make you fat.” I like that.
Most people just look at her in wonderment and disbelief. Some say, politely,
“I never heard that before.” I secretly wonder if they think she is crazy.
She’s not a scientist or a doctor, and doesn’t even play one on TV. Where does
she get these crazy ideas? Maybe she reads my blog. Maybe she doesn’t believe
everything she hears on TV, or reads in the popular press. Maybe…just maybe…the
word is gradually seeping out there that “the conventional wisdom,” that we
have been following for the last 50 years, has been wrong. Maybe it HAS all been a big fat
lie, as Gary Taubes suggested in his seminal NYT piece, which appeared on
the cover of the Sunday magazine on July 7, 2002. If you’ve never read it, you
can access it here.

Wednesday, August 21, 2013

“No butter on your corn?” I didn’t
really say it, but I thought it. Our dinner guest the other night said he would
“pass” on butter for the ear of corn that my wife had prepared as part of our
dinner. In our house we only eat corn “in season,” and that means “in season in
our immediate neighborhood,” so she can be certain it was picked that day. We
also had local tomatoes and a meat course of beef short ribs prepared in a
special way that I love. For dessert we had local blueberries with heavy cream.
For a Low Carber like me, this was a “special occasion” when rules are meant to
be broken (LOL).

But “no butter” on corn is not one of those rules. Besides, without butter, how can you
get all the extra salt to stick? (LOL, again). Well, it turns out our dinner
guest was taking a statin for his “high cholesterol” and was under the care of
a physician who advised him to eat a diet low in saturated fat. That’s a
surmise on my part – the saturated fat part, not the statin part – but a pretty
safe one. Most physicians, and the general public, still believe the diet/heart
hypothesis that associates saturated fat and dietary cholesterol with heart
disease. Regular readers here, and in a gazillion other places in the Ethernet
and in the print world, know that that hypothesis has been completely disproven
– that ingestion of saturated fat does not
cause heart disease, and dietary cholesterol (the cholesterol you eat)has nothing
to do with serum cholesterol (the cholesterol in your bloodstream).Here’s one site of legions for a start if you
want to do your own research: Heart-surgeon-speaks-out-on-what-really-causes-heart-disease.If you prefer a book, Dr. Malcolm Kendrick’s “The Great
Cholesterol Con” is a good read. His video “Statin Nation – The
Documentary” (first 13 minutes) can be seen here.

The incident did give me
pause for thought, though, and my mind drifted to my column. We hadn’t seen our
guest for several years and so, for conversation, I mentioned that I was
writing and publishing a blog twice a week. Our guest seemed interested and
asked the subject. When I said “nutrition,” his reply was, to the effect, what
qualified me to write about nutrition. I found myself on the defensive, and not
very well prepared. Our guest was a very successful, now retired attorney, but
his training, life-long experience and instincts were still sharp. And my
answer pretty lame.

Nevertheless, I told him that my course of self-study included a large library
of books, articles and scientific papers I had read. He didn’t seem impressed.
Afterwards my wife told me that I should have added my personal (n = 1)
experience. She was right of course. I had lost 170 pounds and put my long-term
type 2 diabetes in remission, which allowed me to discontinue two oral diabetes
meds and reduce the third by three-quarters (to 500mg Metformin once a day). I
had also vastly improved my glucose control (as evidenced by my A1c’s) and had
dramatically improved my blood pressure (on the same meds). But here’s the
zinger I had in my quiver and had failed to use: I was able to discontinue taking statins!

I had at
one time been taking 80mg of Lipitor a day to get my LDLs down to under 70,
which my doctor advised due to multiple “risk factors.” I was able to
discontinue the statin because, as I changed my diet, my HDL more than doubled
and my Triglycerides fell by two-thirds. As a result, although my recent Total
Cholesterol was still above 200 (215), and my LDL above 130 (133), my HDL was
70 and my triglycerides 58. My new doctor, an internist and cardiologist,
wrote: “your cholesterol profile currently conforms to the NCEP-3
standards.”The reason, in part, his
letter continued: “A high HDL may mitigate some of this risk. Triglycerides
should be 150 or less.” These National Cholesterol Education Program guidelines
are used almost universally to inform clinicians on statin use, but they’re
about to change, according to this
story from “Nature,” reprinted in “Scientific American.”

On my latest visit, I asked for a VAP ™ cholesterol test to get more
detail. This time my Total Cholesterol was 219, my LDL 131, my HDL 75 and my
triglycerides 47. The best news in the VAP test though was that my LDL
size/pattern was, “Pattern A – Large Buoyant LDL.” This news didn’t seem to
impress my doctor, but it made my day.
The doctor’s note on my lab report: “Stable, Similar to (previous visit).” So,
bingo! No statins for me. Eat the right diet, not the so-called “healthy diet” that is making so many
Americans, and people worldwide who eat a Western Diet, so very sick, AND YOU
TOO MAY BE ABLE TO STOP TAKING A STATIN.That is what I should have told our dinner guest. But I was too stupid,
or too surprised, or perhaps too polite to tell him. Besides, it’s so much
easier to have the perfect riposte, in writing, and a day late…

Saturday, August 17, 2013

“What
about physical energy?” That’s the header of a paragraph on the home page of a
website from the UK called “The
Low Carb Diabetic.” It describes how many people report they feel more energized on a
low carb diet than they do on a “balanced” diet that includes lots of
carbohydrates. I have reported this myself many times in “The Nutrition
Debate,” and J. Stanton of Gnolls.org reported it in a blog post some months
back here. His headline was “There’s
Another Level Above ‘I’m Feeling Fine.” His conclusion: “Result: I’m in the
best physical and mental shape of my life. I don’t feel ‘fine’: I feel great.
Some days I even feel unstoppable.” I couldn’t agree more, but it’s very
subjective. How do you measure it?

Well, “The Low Carb
Diabetic” gives us a way to measure it. I never studied organic chemistry, so I
can’t attest to the veracity of this quantitative explanation of the increased
energy from a VLC ketogenic diet, but here is his postulation:

“Strictly speaking, we burn neither glucose nor fat
for physical energy. Energy within our cells actually comes from a molecule
called adenosine triphosphate, or ATP. When its molecular bonds are broken,
energy is released in the mitochondria, the power plants of our cells. A
glucose molecule will generate 36 ATP molecules. A 6 carbon fatty acid molecule
will generate 48 ATP molecules. Therefore, when insulin levels are low and the
body can access fatty acids as a fuel source, physical energy levels can
actually increase on a low carb diet. Anecdotally, many on low carb diets often
report feeling considerably more energetic, without the peaks and troughs of
energy which appear to come with a diet high in carbohydrates.”

Do the math: 48 ATP
molecules from a fatty acid molecule vs. 36 ATP molecules from a glucose
molecule. That’s one third more energy! Of course, I don’t know if it really
works that way, but it is reaffirming for me to see a tangible and plausible
explanation for my sense of an increased and stable level of energy. I like to
say I feel “pumped” all the time when I am in a ketogenic state. Is it because
I am using ketones for energy? Who knows, and who cares really. It is a very
real feeling to me. I like never feeling tired and always full of energy and
“pep.” I feel like I’m a kid again.

Whatever the explanation,
barring any thyroid condition, the reality is that you can feel great on a diet
that is Very Low Carb (VLC). I am defining VLC at 20 to 30 grams of
carbohydrate a day (or less, even). The body has no minimum
requirement for dietary carbs. It will make all the glucose it needs (for
certain cells that do not have ATP “power plants”). And the brain and the heart
love to use ketones for energy. There are actually several medical conditions
that benefit from very restricted carb diets, including childhood epilepsy and
PCOS. Certain cancers use glucose for fuel, and several scientific papers have
shown a ketogenic diet as therapeutic for treating those cancers.

Besides the increased
physical energy benefit from eating VLC, there is the element of mood
elevation. Again, this is anecdotal, but I am almost “hyper” when I am in a
ketogenic state. I’m not talking about “ups” and “downs” though, as if I were
taking “speed,” which is slang for amphetamines. I am talking about a stable
and elevated mood level.

Amphetamines, as an aside,
were once prescribed as “diet pills.” Dexamyl and Dexedrine were routinely administered
to help people lose weight, or elevate mood (as anti-depressants) or stay up
all night to prepare for an exam. In my youth I foolishly “did” them. Then, in
the late 60’s, a Dr. Stillman came out with a “high protein/low fat” diet. I
did that diet with amphetamines in the morning and barbiturates at night to
regulate my body’s energy level. As I recollect, the Stillman Diet was the
first “diet” I ever tried. I lost 65 pounds, but soon thereafter regained it
all.

Anyway, all that was
foolishness. I am an older and much wiser man now. I have come to accept that
1) I have a broken metabolism with the result that I am insulin resistant and
as a consequence cannot tolerate carbohydrates in my diet; 2) that the best way
to “correct” my hyperglycemia, hypertension and hyperlipidemia, as well as lose
weight permanently and regulate and stabilize my energy levels, is to eat a
Very Low Carb ketogenic diet every day for the rest of my life. It is a
lifestyle change. It is a Way of Eating (WOE) that I find delicious and very
satisfying – both in the sense of pleasurable as well as satiating. I feel
“full” on very little food. I don’t feel hungry. I never snack and often
“forget” to eat lunch.

Feeling full on a really
small meal is a new paradigm, and it takes a little getting used to. When I
told my egg vendor at the farmer’s market recently that I had decided to
increase my daily serving of eggs at breakfast from 2 to 3, and reduce the
bacon from 2 strips to 1, she asked me, “Is that all you have?” She was genuinely
surprised. No juice. No bread. No jam or jelly. Just protein and fat. I told
her “yes,” except for a heaping teaspoon of ghee in my coffee.

When I recently told the
nanny of my step daughter’s children that I just eat a can of sardines packed
in olive oil for lunch, she said, “Is that all you eat?” Again, I said “yes,”
and I eat it even though I am not hungry at lunch time. Maybe I need to rethink
that lunch. Why am I eating lunch if I am not hungry? Why indeed! I am running
on my fat reserves, my body loves its ketones, and I am full of energy.Maybe even one-third more physical energy
than on glucose!

Wednesday, August 14, 2013

“You really don’t need to
test,” my new doctor, an internist and cardiologist (and PHD!), told me
recently as I was leaving his office. It was only my second visit, and it was
at my suggestion that I will see him
3 times a year instead of once, so I think it was a nice gesture on his part to
give me assurances and comfort that my health in general, and in particular my
type 2 diabetes and hypertension, were “under control.”

He was also telling me that
my other labs, specifically my A1c, blood pressure, and Lipid Panel, all
suggested – to him – that the therapeutic regimens that his predecessor
had ordered and he was continuing, had me in good shape. I got the impression
that seeing me, for him, was a bit of a relief – that most of the patients he
saw on a daily basis were truly sick people. I was “healthy,” by comparison,
and that made his time with me easier for him. He almost seemed, to me, to be
having fun! I liked that. It made me feel good too.

But here’s the rub. He was
telling me that my condition didn’t warrant the level of blood glucose testing
that I had requested he prescribe for me: two times a day. His rationale was
that my A1c, at 5.6% at the time, as it was less than 5.7%, was regarded as a
value consistent with an “Decreased Risk of Diabetes.” This “Reference Range,”
the Quest Diagnostics lab report said, was “supported by the current ‘Standards
of Medical Care in Diabetes’ published in January of the current year in
Diabetes Care, the Journal of the American Diabetes Association.” So, that’s
that. He was ‘covered’ because the ADA says that I am at decreased risk of
diabetes, so ipso facto daily testing
was not warranted. For the new reader, and to remind regulars (and my doctor),
I have been a full-blown, diagnosed type 2 diabetic for 27 years.

Never mind that the report
generated by the blood drawn at that consult showed an increase in my A1c to
5.8%, which is considered consistent with an “Increased Risk of Diabetes.” But
elsewhere in this same report, based on the results of a VAP (TM) Cholesterol
Test that I requested, Quest advised, in response to the question, should the
physician “CONSIDER INSULIN RESIST/METABOLIC SYNDROME,” the response was a flat
“NO.” Never mind that I AM today insulin resistant and, before I changed
my diet, had ALL of the indications of Metabolic Syndrome. See “The
Nutrition Debate #9” for a complete list of the indications and ranges if
you would like to see if YOU have an undiagnosed case of Metabolic
Syndrome.

So, how can all of these
seeming paradoxes coexist? Why is it that my diabetes is no longer discoverable
by a lab test or a clinician’s interpretation? They would be, of course, with a
full medical history, but my new doctor is only acquiring that as he gets to
know me. A good sign: he offered to be added to the email distribution of my
twice-weekly diabetes blog. How cool is that! My previous (now deceased) doctor
also was on the list and occasionally emailed me with comments.

Anyway, I digress. My reason for writing this
post is to make the point that the
patient who has taken control of his diabetes health care, and treats it almost
entirely with diet alone, can achieve these results EVEN IF HE OR SHE IS
INSULIN RESISTANT. When you eat very few carbohydrates, your blood
insulin level goes down, and your insulin sensitivity goes up. Insulin
sensitivity is the inverse of insulin resistance. And importantly, your blood
glucose stabilizes.

A few months ago I asked an
endo in Florida to do a HOMA Assessment to determine my beta cell function and
insulin sensitivity. The results surprised me, since I had been maxed out on a
sulfonylurea for the better part of 20 years. Beta Cell Function: 68.2%.
Sensitivity: 94.6% and IR 1.1 (1.057). I attribute these “good” results to my
Very Low Carb diet.

And when you achieve these
results through strictly eating Very Low Carb, YOUR TYPE 2 DIABETES WILL BE IN
REMISSION. The lab can’t tell that you’re a full-blown type 2 diabetic. Neither
can your doctor, if he doesn’t know your history. But that doesn’t mean you can
rely on the assurances that you’re in “good control” just because you are well
below the thresholds of the American Diabetes Association for being “Consistent
with Diabetes (> or = 6.5). You don’t want to be there. You don’t
want your type 2 diabetes to be a PROGRESSIVE DISEASE, as the ADA defines it.
And by extension your physician will too, if he/she follows the “Standards of
Medical Care in Diabetes, as most will likely do.

YOU can treat yourself
through diet, and the best way to do that is to learn about the carb content of
the foods you eat and how your metabolism handles them. And the only way to do
that is to test.Test before and 1-hour after a suspect
meal. Adjust the menu to meet your goals. Test in the morning before
eating (fasting blood glucose). Test to keep yourself honest - to remind
yourself that you are diabetic and will always be carbohydrate intolerant.
You cannot cure this disease. You can only treat it. And the absolute best
way to treat it is with diet. Vigilance is required. And some discipline.
But the food choices are endless, and very good. As your body adapts to using
ketones, you will have increased physical energy. (See the next column.) You
will feel better. And if you need to lose weight, you can do so easily (with
calorie restriction) and without hunger. What more can you ask?

Saturday, August 10, 2013

“…and
the abandoned school cafeteria became the kitchen classroom.” Wow! That’s transformative.
I read this in a history of the Edible Schoolyard Project at the Martin Luther King, Jr. Middle School
in Berkeley, California. Alice Waters, the legendary doyenne of California Cuisine,
was the impetus behind ESY in 1995 and now supports it through her Chez Panisse
Foundation. “California
Cuisine is a style of cuisine marked by
an interest in fusion cuisine (integrating disparate cooking styles and
ingredients) and in the use of freshly prepared local ingredients,” according
to Wikipedia. New American Cuisine derives from California Cuisine. Alice
Waters’ influence the world over on cooking with fresh, local ingredients is undeniable.
Would that how we teach our children about food everywhere were equally
transformative.

I
was directed to this site, and another, Edible
Schoolyard New Orleans (ESYNOLA), by
Randy Fertel, a neighbor. As co-chair of the ESYNOLA Task Force, Randy told me,
with justifiable pride, that in just the last 7 years New Orleans has
established an offshoot of ESY in 5 FirstLine public open-enrollment charter schools.
In his words, paraphrasing, “…when children are engaged in the growing,
harvesting, and preparing of food, they are far more likely to eat it.” According to their website, “Edible Schoolyard New Orleans changes the way children
eat, learn, and live...” “Our mission is to improve the long-term well being of
our students, families, and school community by integrating hands-on organic
gardening and seasonal cooking into the school curriculum, culture, and
cafeteria programs.” What a great idea!

It’s hard for me to
imagine an “abandoned school cafeteria” in a fully functioning Middle School (grades
7, 8 and 9), especially in an economically disadvantaged neighborhood. I have
never been a parent, so my exposure to the policies and politics of school
lunch programs is nil, but I do read the paper and listen to and watch the
news. On the local level, the issues revolve around whether flavored milk
should be banned from the cafeteria. Eight
ounces of white milk contains 14 grams of natural sugar or lactose; fat-free
chocolate milk has six grams of added sugar for a total of 20 grams, while
fat-free strawberry milk has a total of 27 grams — the same as eight ounces of
Coca-Cola. Flavored milk is like candy. Others argue that vending
machines should be banned altogether, or just allowed if they are limited to
“healthy” snack foods, defined as low in saturated (solid) fats like butter and
made with just enough partially hydrogenated polyunsaturated vegetable oils to
escape having to be labeled as containing dangerous trans fats.

At the Federal level, the
U.S. Government has recently reentered the fray with the latest version of the USDA’s
167 page National School Lunch and School Breakfast Program. Even our First Lady, Michelle Obama, is out “on the stump” in
support of the Healthy Hunger-Free Kids Act. Here’s an easier to read overview of school lunch and breakfast programs.

More fresh fruits and vegetables and less added
sugar are great goals. The most worrisome part of the new school lunch
guidelines is the emphasis on reduced saturated fat. Regardless of what you
think about saturated fat in the adult diet, children are rapidly growing and
developing brain tissue. The other functions of saturated fat (from The Skinny of
Fats):

·Cell Membrane Function – 50 percent of the fats in cell
membranes must be saturated for the cells to function properly.

·Lung Function – The lungs cannot function without saturated
fats, which explains why children fed butter and whole milk have much less
asthma than children fed margarine and low-fat milk.

·Kidney Function – The kidneys operate through a process
that requires saturated fat.

·Brain and Nervous System – The normal brain is especially rich
in saturated fat (and also cholesterol).

·Protection against Infection – Some kinds of saturated fats
(found in coconut oil and butter) help fight pathogenic bacteria, viruses
and parasites. Children fed skim milk suffer from infection five times more
frequently than children fed whole milk.

·Vitamin Carriers – Saturated animal fats serve as unique
sources of important nutrients such as vitamins A and D, and CLA.

So, the Edible
Schoolyard is a breath of fresh air. I don’t care that there is no mention of
animal products in any of the website offerings, except for eggs in the ESY
Berkeley program. There are, after all, limitations to what you can do on a one
acre plot of ground adjacent to a classroom building. And besides, if the
Ruth’s Chris Steak House guy (Fertel) can get behind a program like this, he
must have made a similar assessment about the program: “The
mission of the Edible Schoolyard Berkeley is to teach essential life skills and
support academic learning through hands-on classes in a one-acre organic garden
and kitchen classroom. The Edible Schoolyard curriculum is fully integrated
into the school day and teaches students how their choices about food affect
their health, the environment, and their communities.” I like it.

What are you doing about
nutrition in your school’s lunch program? Or what would you do if the government stayed out
of what foods you could serve/not serve in your school instead of pimping for
the agribusiness lobby in Washington DC?

Wednesday, August 7, 2013

Chatting with an MD Internist
friend of mine, my hopes for the future of the medical care of his diabetic
patients sunk to an abysmal low. Admittedly it was a social situation, and in
fairness my friend did not express much interest as I proselytized about my
self-treatment (VLC dietary) regimen for my own type 2 diabetes. However, the
pain and despair I felt for his patients, when referring to how he treated them,
was in his use of the terms “good diet” and, referring to blood sugar, “under
control.” I rudely interrupted him on both phrases since I was sure he and I
had a totally different concept of the meaning of these terms. I must have
seemed insufferable to him.

This is a problem of immense dimension and import.
Until the entire public health and medical establishment comes to see these two
terms in a different context, I fear that the world-wide epidemic of obesity
and diabetes (“diabesity”) will continue to worsen. The small town practitioners
are not the root of the problem. They just follow what they have been taught
and continue to learn on an on-going basis from their medical societies. And
the patient accepts the scripts his or her doctor writes, as well as the
assurances he or she gives the patient, because it conforms to the messaging
from the corrupt Government/Big Pharma/Agribusiness/Media consortium. This is
not conspiracy theory. Just follow the money.

I challenged “good diet” when my internist friend
mentioned it since I was sure he meant a “balanced” low fat diet. In other
words, the one-size-fits-all diet the government recommends: 60% carbohydrate,
30% fat, and 10% protein. It’s on the HHS/FDA/USDAs Nutrition Facts label. The fat category subdivides into only 10% “solid”
(saturated fat) and more unsaturated fat, especially vegetable and seed oils
(corn and soy bean oil, among others). These are unstable and inflammatory. See
The Nutrition Debate #21, here. This is not a healthy diet for anyone.

“Under control” is the other phrase over which I
became exercised. By this point my friend was backing away from the
conversation so I didn’t get a chance to explore whether he was referring to an
A1c of 7.0% (the ADA standard), or 6.5% which has for a few years now been the
standard of the AACE, the endocrinologist’s society. If I had had the opportunity
I would have mentioned that “good control” should
be defined as an A1c <6.0%, as Dr. Ralph DeFronzo, MD, stated in his Banting
Award lecture at the 2008 ADA convention in San Francisco: “Further, a more
rational goal of therapy should be an A1c <6.0% …” His “Treatment Summary”
in the published paper
is as follows:

“Although
this paradigm shift, which is based upon pathophysiology, represents a novel
approach to the treatment of type 2 diabetes, it is substantiated by a vast
body of basic scientific and clinical investigational studies. Because this
algorithm is based upon the reversal of known pathophysiological defects, it
has a high probability of achieving durable glycemic control. If the plasma
glucose concentration can be maintained within the normal nondiabetic range,
the microvascular complications of the disease, which are costly to treat and
associated with major morbidity and mortality, can be prevented. Most
importantly, this will enhance the quality of life for all diabetic patients.”

“Good Control,” of course, from a doctor’s
perspective, means controlled with medications, either oral or injected. And good control as defined by the
associations (ADA and AACE) assures that the patient will take progressively
more and more said medication as the disease “progresses.” Type 2 diabetes is
defined as a “progressive disease,”due entirely to the treatment regimen
that these same associations advocate. Why is that?

“That’s a very hard question to answer,” replied Dr. Jay
Wortman, MD, a Canadian low-carb
blogger, to Dr. Andreas Eenfeldt, MD, a
Swedish doctor known as the Diet Doctor, in a recent video interview.
You can watch the entire 25-minute video, but the 2 minute excerpt from 19:20
to 21:25 is particularly riveting. Here are parts of that dialogue:

(Wortman) “I think there’s a multiple answer to that
question. I think there’re a lot of people in organizations and positions that
are funded by the drug industry, and the drug industry doesn’t want people doing
this (“a simple dietary change”). They’d get off the drug.” (Eenfeldt) “Bad for
Business.” (Wortman) “Yeah. Bad for business – totally bad for business. And
these big organizations (ADA, AHA, etc.) depend on drug industry funding.”
(Wortman, later) “The other problem is there’s nothing to patent there. There’s
nobody going to get wealthy from patenting this (simple dietary change). Our system
runs on something that can be patented and marketed, and turn a profit, and
that’s how the funding goes through the system in terms of both the research
agenda and also how recommendations are generated, and there’s nothing to
patent.”(Eenfeldt) “Right. It’s all free information, right?” (Wortman) “It’s
freely available.”

Saturday, August 3, 2013

If you don’t know who
“Bernstein” is, let me explain. Richard K. Bernstein, MD, is a type 1 diabetic
who, in my opinion, single-handedly innovated and championed the wide-spread
use of the personal glucose monitoring device. Forty odd years ago he was a
practicing engineer, and his wife an MD, so he had access to her bulky hospital
equipment that was the only way of determining blood sugar measurements “in the
old days.” Bernstein had been following medical guidelines for type 1s up to
that point in his life and was dismayed to see that he was developing diabetic
“complications” (neuropathy and retinopathy) in his early 30’s. With the meter,
he observed that certain foods caused his blood sugar to rise, and others not,
so he reasoned that he could control his blood sugar by what he ate. Sounds
reasonable, right?

Every diabetic in the world, and ideally every
pre-diabetic too, should be using a meter both before and after meals and at
other critical times of the day and night. When Bernstein did, he gained
control over his blood glucose and reversed
his complications. Ever since, his over-arching philosophy has been that
“people with diabetes are entitled to the same blood sugar as people who don’t
have the disease.” Bernstein has been a type 1 for 69 years. His A1c’s today
are always in the 4s.

So, Bernstein went to school, both literally (to
medical school) and figuratively, and has been promoting very low carbohydrate
eating ever since. In an article in the magazine “Diabetes Health,” which I
read recently through a link in Low Carb Diet News, Bernstein says, “To get normal blood sugars you have to do certain
things, and one of the key things is a very low carbohydrate diet. This is
because nothing else works. I’ve tried other approaches throughout my 69 years
of having diabetes. I got my first meter in 1969, so I’ve had plenty of time to
experiment and see what works.”

Over the years Bernstein has developed a “concept diet,”
the Bernstein Diet, also called a Way of Eating (WOE). In it, you eat 30 grams
of carbohydrates a day: 6 grams at breakfast, 12 at lunch, and 12 at dinner.
The lower amount at breakfast is due to something called Dawn Phenomenon (DP)
which some people experience. The body makes a little glucose and circulates it
upon waking to enable it to be used for quick energy to get you going (before
caffeine). Bernstein recommends that you eat 3 small meals a day, evenly spaced
about 5 hours apart. He advocates that protein, a large part of which is
glucogenic (i.e., will make glucose if it is not taken up my muscles, etc.), be
roughly equal amounts in each meal and not too much. Gluconeogenesis, where the
liver makes glucose from excess amino acids (digested protein), can sabotage
very low carbohydrate (VLC) eating.

His popular book, “Diabetes
Solution,” has gone through several
editions and is a best seller. If you decide to try VLC, don’t be afraid to eat
saturated fats. In fact, Bernstein says in the Diabetes Health article,
“There’s no way the ADA diet or any high-carbohydrate and low-fat diet will
enable you to control blood sugars.” He’s very definite about that.

But here’s what blew me away about the Bernstein
article. He goes on to say, “It turns out that the kind of diet I recommend is
essentially a Paleolithic diet, which is what humanity evolved on. Our
ancestors did not have bread, wheat, sweet fruits, and all of the delicious
things we have today. These have been specially manufactured for us nowadays.
For food, our ancestors ate a paucity of roots, some leaves, and principally
meat. If they lived near the shore, they had fish.”

Bernstein concludes, “My dietary recommendations boil
down to what our ancestors ate. The ADA repeatedly says that while
low-carbohydrate diets may work, they’re an experiment, and we haven’t had enough
years of trial of these diets to see if they do any harm. But in reality the
ADA diet is an experiment that was never based on any history. In fact, it is
the cause of the epidemic of obesity and diabetes that is currently shaping our
nation. Whereas the original diet, the Paleolithic diet, has been tested for
hundreds of thousands of years, and it’s the only one when you deviate from it
that you end up where we are now.” He’s absolutely right, of course. That’s the
simple truth. I’m just surprised he said it.

So, my hat is off to Richard K. Bernstein, MD, for
seeing “the big picture” and speaking the truth. It’s rare enough for someone
“inside” the medical establishment to see, much less speak, truth to power,
even as it takes the focus off his own well established brand and carb-centric reputation.
In my view, it elevates him a notch or two. Dr. Bernstein’s place among the
pioneers of medicine is secure. And his place in the firmament of diabetes
treatment is likewise assured. Now, in advocating Paleo principles, his vision
is more far reaching yet and embraces how all
of us should eat going forward.

Eleven years ago I bought a meter and used it to “eat
to the meter” and thereby learn what foods had an impact on my blood sugar and
by how much. It was an invaluable adjunct to general principles and guidelines
and enabled me to fine tune my eating habits to the point where I was able
lower my A1c’s from the 8s, while maxed out on 2 oral diabetes meds and
starting a 3rd, to the mid 5s, today, by diet alone, except for
500mg of Metformin once a day. This medication works to suppress unwanted
glucose production by the liver, from eating too much protein in a meal. My
pancreas is spared.

Do others see how Very
Low Carb and Paleo can be compatible? For caveats on the Paleo part for type 2
diabetics, see The Nutrition Debate #124, “A Lamentable Confusion Between Diets.” Do you know any
diabetics (type 1s or 2s) in their 70’s?

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.